California Assisted Living and In-Home Care Medicaid Waiver Information and Rules for 2017

Introduction

California provides long-term care resources to seniors through its Assisted Living Waiver, available in only certain counties. The program works to help seniors who are either already in a nursing home, or would otherwise require a nursing home level of care to reside in their own home or a community setting while still receiving Medicaid benefits for long-term care.  

Medicaid Waiver Program for Assisted Living and In-Home Care

California Assisted Living Medicaid Waiver (HCBS Assisted Living Waiver)

The Assisted Living Waiver (ALW) is an alternative to long-term placement in a nursing facility and is presently available in the following counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Mateo, Santa Clara, and Sonoma. The ALW is currently enrolling beneficiaries residing in skilled nursing facilities and in the community, into licensed Residential Care Facilities (RCF) and Public Subsidized Housing (PSH).

The goal of the ALW is to: 1) facilitate a safe and timely transition of Medi-Cal eligible seniors and persons with disabilities from a nursing facility to a community home-like setting in a Residential Care Facility (RCF), an Adult Residential Care Facility (ARF), or public subsidized housing, utilizing ALW services; and 2) offer eligible seniors and persons with disabilities, who reside in the community, but are at risk of being institutionalized, the option of utilizing ALW services to develop a program that will safely meet his/her care needs while continuing to reside in a RCF, ARF, or public subsidized housing.

Services

Services included in the ALW are: 24-hour awake staff to provide oversight and meet the scheduled and unscheduled needs of residents (24-hour awake staff is not required in RCFs with 6 beds or less); Provision and oversight personnel and supportive services (assistance with activities of daily living and instrumental activities of daily living); Health related services including skilled nursing (e.g., medication management services, treatments, wound care,etc.); Social services; Recreational activities; Meals; Housekeeping and laundry; and Provide or arrange transportation.

Additional services may include: Assistance in developing and updating ALWP participant's Individualized Service Plans (ISP) which details in part, the frequency and timing of assistance. Participants play active roles in thedevelopment process and must sign their ISP; Providing personal care and assistance with Activities of Daily Living and Instrumental Activities of Daily Living; Washing, drying and folding laundry; scheduled and unscheduled needs of the residents; Performing all necessary housekeeping tasks; Maintaining the facility; Providing three meals per day plus snacks (food must meet minimum daily nutritional requirements and meet the resident's special dietary needs as prescribed by their PCP); Providing intermittent skilled nursing services as required by residents; In accordance with State law, providing assistance with self-administration of medications, or administering medications by an RN or LVN; Providing or coordinating transportation; Providing daily recreational activities; Providing social services; Providing a response system that enables waiver beneficiaries to summon assistance from personal care providers.

Eligibility

  1. Health: An applicant must require a Nursing Home Level of Care.
  2. Financial: An applicant must either be an SSI recipients, or meet certain income limits as determined by the waiver, which in the case of the ALW is 100% of the Federal Poverty Line. However, California allows an applicant to spend down their income on medical and remedial care in order to reach the limit, as a “medically-needy” state. For the non-applicant spouse, if married, the traditional SSI and Spousal Impoverishment. Criteria set by the federal government apply and the community spouse may keep a certain amount of assets and receive a monthly income that will not affect the eligibility of the applicant spouse. For 2017, the community spouse resource allowance (CSRA) is $120,900; and, the community spouse may keep an additional $3,022.50 per month in income, known as the Maximum Monthly Maintenance Needs Allowance (MMMNA) in order to live off of while their spouse is participating in the ALW program.

Practical Considerations

The fact that the income limit in California is 100% of the Federal Poverty Level, even with the “medically-needy’ spend down provision makes qualifying for the program more difficult. Also, the limited number of slots and limited scope of this waiver (geographically and services provided) mean that it will be hard to qualify for eligibility.

Conclusion

California is not a great state for seniors wishing to reside in their home or community setting instead of a nursing facility because of the eligibility requirements and certain restrictions on availability of the program.